1
|
da Silva Martins WC, de Albuquerque LAF, de Carvalho GTC, Dourado JC, Dellaretti M, de Sousa AA. Tenth case of bilateral hemifacial spasm treated by microvascular decompression: Review of the pathophysiology. Surg Neurol Int 2017; 8:225. [PMID: 29026661 PMCID: PMC5629840 DOI: 10.4103/sni.sni_95_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bilateral hemifacial spasm (BHFS) is a rare neurological syndrome whose diagnosis depends on excluding other facial dyskinesias. We present a case of BHFS along with a literature review. METHODS A 64-year-old white, hypertense male reported involuntary left hemiface contractions in 2001 (aged 50). In 2007, right hemifacial symptoms appeared, without spasm remission during sleep. Botulinum toxin type A application produced partial temporary improvement. Left microvascular decompression (MVD) was performed in August 2013, followed by right MVD in May 2014, with excellent results. Follow-up in March 2016 showed complete cessation of spasms without medication. RESULTS The literature confirms nine BHFS cases bilaterally treated by MVD, a definitive surgical option with minimal complications. Regarding HFS pathophysiology, ectopic firing and ephaptic transmissions originate in the root exit zone (REZ) of the facial nerve, due to neurovascular compression (NVC), orthodromically stimulate facial muscles and antidromically stimulate the facial nerve nucleus; this hyperexcitation continuously stimulates the facial muscles. These activated muscles can trigger somatosensory afferent skin nerve impulses and neuromuscular spindles from the trigeminal nerve, which, after transiting the Gasser ganglion and trigeminal nucleus, reach the somatosensory medial posterior ventral nucleus of the contralateral thalamus as well as the somatosensory cortical area of the face. Once activated, this area can stimulate the motor and supplementary motor areas (extrapyramidal and basal ganglia system), activating the motoneurons of the facial nerve nucleus and peripherally stimulating the facial muscles. CONCLUSIONS We believe that bilateral MVD is the best approach in cases of BHFS.
Collapse
Affiliation(s)
| | | | - Gervásio Teles Cardoso de Carvalho
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jules Carlos Dourado
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Marcos Dellaretti
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Neurosurgery, Hospital das Clínicas de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Atos Alves de Sousa
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
2
|
Dou NN, Zhong J, Liu MX, Xia L, Sun H, Li B, Li ST. Management of Bilateral Hemifacial Spasm with Microvascular Decompression. World Neurosurg 2015; 87:640-5. [PMID: 26548830 DOI: 10.1016/j.wneu.2015.10.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bilateral hemifacial spasm (HFS) is very rare. The literature contains only 32 clinical reports. Although microvascular decompression (MVD) is widely accepted as effective therapy for HFS, the etiology and surgical treatment of bilateral HFS are seldom addressed. We report our experience with MVD for patients with bilateral HFS. METHODS This retrospective report included 10 patients with bilateral HFS. All patients underwent MVD 1 or 2 times and were followed for 5-92 months. The clinical data were retrospectively analyzed. The etiology and treatment strategies were discussed. RESULTS Spasm stopped completely on the operative side in all 10 patients. Symptoms on the other side also resolved in 3 patients, improved in 1 patient, and did not improve at all in 6 patients. Of the 6 patients with no improvement, 5 underwent another MVD on the contralateral side within 1 year and experienced relief of symptoms, and 1 patient refused the surgery. The neurovascular conflict was found in all the operations. During the follow-up period, no complications of hearing loss or facial palsy and no recurrence were observed. CONCLUSIONS Vascular compression was the cause of bilateral HFS in our patients, and MVD relieved the symptoms. Thus, we recommend MVD for patients with bilateral HFS. A crowded cerebellopontine angle space and easy attrition of the neurovascular interfaces may play important roles in the occurrence of bilateral HFS. For some patients, 1 MVD can resolve bilateral symptoms.
Collapse
Affiliation(s)
- Ning-Ning Dou
- Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jun Zhong
- Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Ming-Xing Liu
- Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Lei Xia
- Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hui Sun
- Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bin Li
- Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shi-Ting Li
- Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Oh CH, Shim YS, Park H, Kim EY. A case of hemifacial spasm caused by an artery passing through the facial nerve. J Korean Neurosurg Soc 2015; 57:221-4. [PMID: 25810866 PMCID: PMC4373055 DOI: 10.3340/jkns.2015.57.3.221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 12/24/2013] [Accepted: 01/04/2014] [Indexed: 12/05/2022] Open
Abstract
Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques.
Collapse
Affiliation(s)
- Chang Hyun Oh
- Department of Neurosurgery, Guro Teun Teun Hospital, Seoul, Korea
| | - Yu Shik Shim
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Hyeonseon Park
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Eun-Young Kim
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| |
Collapse
|
4
|
Mehanna R, Jankovic J. Movement disorders in multiple sclerosis and other demyelinating diseases. J Neurol Sci 2013; 328:1-8. [DOI: 10.1016/j.jns.2013.02.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/05/2013] [Accepted: 02/13/2013] [Indexed: 02/08/2023]
|
5
|
Felício AC, Godeiro-Junior CDO, Borges V, Silva SMDA, Ferraz HB. Bilateral hemifacial spasm: A series of 10 patients with literature review. Parkinsonism Relat Disord 2008; 14:154-6. [DOI: 10.1016/j.parkreldis.2007.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/27/2007] [Accepted: 06/04/2007] [Indexed: 10/22/2022]
|
6
|
Tarnaris A, Renowden S, Coakham HB. A comparison of magnetic resonance angiography and constructive interference in steady state-three-dimensional Fourier transformation magnetic resonance imaging in patients with hemifacial spasm. Br J Neurosurg 2008; 21:375-81. [PMID: 17676458 DOI: 10.1080/02688690701474564] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although the decision to perform a microvascular decompression of the facial nerve is based on clinical history and assessment, preoperative imaging of the neurovascular relationships at the REZ is important to exclude a non-vascular cause or identify dolichoectatic vessels that might influence the surgical approach. We designed the current study to compare the specificity and sensitivity of gadolinium-enhanced 3D fast inflow with steady state precession (FISP) MRA with CISS. The imaging findings of 47 patients that had microvascular decompression for hemifacial spasm were retrospectively reviewed in a single blind fashion. The 47 non-symptomatic sides served as controls. Neurovascular contact could be seen in 13/47 (27.6%) in routine T2 axial scans, in 22/35 (62.8%) in high resolution T2W, in 18/34 (52.9%) in the case of MRA, and in all cases (13) when the CISS sequence was used. This study demonstrated 56.2% sensitivity and 50% specificity for MRA with gadolinium enhancement, whereas the CISS sequence can achieve a sensitivity of 100% in correctly demonstrating neurovascular compression in HFS. Overall accuracy of the two methods was 55.8 and 100% for MRA and CISS, respectively. The CISS sequence is superior in identifying neurovascular compression when compared with MRA. Preoperative knowledge of the compressing vessel has counselling implications and the higher risk of complications should be communicated to the patient. Due to cost and time implications we suggest that MR-CISS imaging replace the enhanced MRA sequence in the detailed preoperative MR assessment of hemifacial spasm.
Collapse
Affiliation(s)
- A Tarnaris
- Department of Neurosurgery, Frenchay Hospital, Bristol, UK.
| | | | | |
Collapse
|
7
|
Tan EK, Chan LL. Clinico-radiologic correlation in unilateral and bilateral hemifacial spasm. J Neurol Sci 2004; 222:59-64. [PMID: 15240197 DOI: 10.1016/j.jns.2004.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 03/19/2004] [Accepted: 04/08/2004] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Bilateral hemifacial spasm (HFS) is rare. Clinico-radiologic correlates utilizing advanced imaging techniques have not been systematically examined in bilateral HFS. The prevalence of bilateral HFS in an Asian population has not been clarified. OBJECTIVES We examined the prevalence and clinico-radiologic correlates of bilateral HFS in a clinic-based cohort and compared the clinical characteristics of unilateral HFS patients with and without contralateral neurovascular contact (NVC) in HFS. METHODS Patients clinically diagnosed with HFS were examined for bilateral symptoms. Imaging analysis involved the utilization of reformatted, multi-planar three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA), and constructive interference at steady state (CISS-MR) sequences. The clinical and imaging data was compared between HFS with and without NVC. RESULTS Amongst 162 consecutive HFS patients, 2 (1.6%) had bilateral symptoms. Both patients had unilateral onset followed by bilateral and asynchronous facial contractions. The contralateral side of the face began to twitch at a mean of 1.5 years later. MRI/A revealed significant NVC of the root exit zone (REZ) of the facial nerve on the ipsilateral side with mild NVC contralaterally. The degree of NVC correlated with the clinical severity of the patients' symptoms. MRI/A analysis of 40 HFS patients with unilateral symptoms demonstrated NVC on the contralateral side in six patients (15%). The mean age and duration of symptoms were not different between HFS patients with and without contralateral NVC. CONCLUSIONS We demonstrated clinico-radiologic correlation between the clinical severity and the degree of NVC at the REZ of the facial nerve in bilateral HFS. Amongst unilateral HFS, there was no significant difference clinically between those with and without contralateral NVC. The low 1.6% prevalence of bilateral HFS in our Asian cohort was compatible with the rare prevalence in other ethnic populations.
Collapse
Affiliation(s)
- E-K Tan
- Department of Neurology, Singapore General Hospital, National Neuroscience Institute, Singapore 169608, Singapore.
| | | |
Collapse
|
8
|
Abstract
We describe five patients with bilateral hemifacial spasm evaluated in a Movement Disorders Clinic to illustrate the clinical characteristics and to draw attention to the differential diagnosis of this condition. All patients had unilateral onset followed by bilateral, asymmetric, and asynchronous facial contractions. The mean age of the patients (4 women and 1 man) was 70.6 years (range, 54-81 yrs), and the mean duration of symptoms was 17 years (range, 2-30 yrs). The facial twitching started in the left eyelid in all cases and the opposite side of the face began to twitch on the average 8.4 years (range, 0.2-15 yrs) later. Imaging studies revealed tortuous vertebrobasilar arteries in three patients. Four patients were successfully treated with botulinum toxin injections. Bilateral hemifacial spasm is a rare, peripherally induced disorder that must be differentiated from tics, dystonia including blepharospasm and other cranial dystonia, and other facial dyskinesias. Botulinum toxin injection appears to be the treatment of choice.
Collapse
Affiliation(s)
- E K Tan
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
| | | |
Collapse
|
9
|
Abstract
Hemifacial spasm (HFS) is a peripherally induced movement disorder characterized by involuntary, unilateral, intermittent, irregular, tonic or clonic contractions of muscles innervated by the ipsilateral facial nerve. We reviewed the clinical features and response to different treatments in 158 patients (61% women) with HFS evaluated at our Movement Disorders Clinic. The mean age at onset was 48.5+/-14.1 years (range: 15-87) and the mean duration of symptoms was 11.4+/-8.5 (range: 0.5-53) years. The left side was affected in 56% instances; 5 patients had bilateral HFS. The lower lid was the most common site of the initial involvement followed by cheek and perioral region. Involuntary eye closure which interfered with vision and social embarrassment were the most common complaints. HFS was associated with trigeminal neuralgia in 5.1% of the cases and 5.7% had prior history of Bell's palsy. Although vascular abnormalities, facial nerve injury, and intracranial tumor were responsible for symptoms in some patients, most patients had no apparent etiology. Botulinum toxin type A (BTX-A) injections, used in 110 patients, provided marked to moderate improvement in 95% of patients. Seven of the 25 (28%) patients who had microvascular decompression reported permanent complications and the HFS recurred in 5 (20%). Although occasionally troublesome, HFS is generally a benign disorder that can be treated effectively with either BTX-A or microvascular decompression.
Collapse
Affiliation(s)
- A Wang
- Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
| | | |
Collapse
|
10
|
|